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r 11.zi 1094671118 <br /> AGE S7DCKTDN <br /> . PAGE 01/01 � <br /> l I Ij 1 7 ��JJ <br /> � � � <br /> SAN JOAQUIN COUNTY EH4 600 NUMBER <br /> JUL 0 9 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> FNli1RIDWEN HEALTH STOCKTON CA 96202 <br /> PE i`' iT,SERVICES '(209)468,3420 <br /> ` PUBLIC RECORDS RELEASE APPLICATION >70 <br /> APPLICANT I Ma C,n BU INESSIAGENCY <br /> I <br /> ADDRESS � aZAJ Q . <br /> PHONE P7 �. (� FACSIMILES <br /> TENTATIVE*APPOINTMENT DATE TIME • <br /> (Phase give 7 to I('buslness days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89,00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS -`�-� y) <br /> SIGNATURE OF APPLICANTr '��q <br /> DATE _Q— <br /> FILE ADDRESS THIS SIDE EPS STAFF USE pNLY <br /> PROGRAM ELEMENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �'❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP} ❑ HOUSING ABATEMENT ❑ <br /> THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 171 ❑ <br /> SOLID WASTE FACILITY <br /> 4 U DERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL SOLID WASTE VEHICLE <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN 0 DAIRY <br /> r-3TIEREDTIERED PERMITTED FACILITY d MOTEUN RAN ❑ PKG TREATMENT PLANT <br /> ❑ TATTOO/BODY PEIRCING ❑ PUMPER TRUGKIYARDlCHEM TOILETS <br /> TEL <br /> Cl MEDICAL WASTE FACILITY Q POOL/SPA o LAND SE APPLICATI SITES r <br /> �CQTHER(PLEASE SPECIFY) <br /> l• List up to ten addresses in the spaca above. Select the type(s)of files from the fist above y checkira <br /> the appropriate box(es). At least one file type MUST be selected, Fax to 209 a list a38 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist.:An a <br /> conirmed <br /> approximately five business days but no later than ten(0)days afterreceip of alppwil lI et ofn. The files <br /> will be held for a maximum of five business days for review. AppolntmertEs should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4• Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> Of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be Confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE + <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS �^ <br /> REVIEWED YES NO <br /> E>,ba9.�:.mss REv1Ew DAr� - <br /> Saersans <br />